TREATMENT PROCEDURE

This is also a way of administering steroids in the epidural space like the cervical epidural steroid injection, but the technique is more specialized and requires the operator to have special skills, training and experience. This procedure is performed only after conventional epidural injections fail to resolve radicular, or radiating, arm pain resulting from a pinched nerve. This is an excellent option for patients who have had persistent arm pain from either cervical disc herniation or neural foraminal (opening through which nerve roots exit the spinal canal) stenosis, or narrowing. The narrowing may be caused by a combination of arthritis of the facet joints, a calcified bulged disc, or an abnormal osteophyte formation. This procedure is very effective, but it is not without risk.

When this technique is used for diagnostic purposes, it is called a selective nerve root injection. Selective nerve root injections, or blocks, are performed to find what level of the spine a pinched nerve is located in. This procedure may be used in addition to a MRI, CT myelogram, or other diagnostic methods.

This is indicated for treating cervical facet joint pain. About 53 – 54% of neck pain is caused by facet joint disease. This procedure is typically used for making a diagnosis, but in rare occasions, it may performed for therapeutic reasons. However, current scientific research does not support this procedure's use as a treatment.

For the diagnosis of facet joint mediated pain, this diagnostic nerve block is performed to make the affected, or suspected, joint numb. If the procedure relieves the pain completely, the procedure is repeated to rule out a placebo, or false positive, response. If the response is positive twice, with the patient receiving adequate pain relief, those nerves may be destroyed using radiofrequency technology (see below) for long term pain relief.

This is performed for treating a lumbar disc herniation or bulge, causing leg and back pain with tingling or numbness. It is also tried in patients with symptoms of neurogenic claudication (intermittent leg pain) from spinal stenosis (narrowing of the spinal canal) or narrowing of the neural foramen which irritates the nerve root.

A lumbar transforaminal injection is another way of administering epidural steroid injections in the lower back. Unlike straightforward epidural injections which are delivered in the posterior epidural space (behind the dural sac that contains spinal cord and spinal nerves), the transforaminal technique allows delivery of the medicine to the anterior epidural space. The anterior epidural space is in front of the dural sac and therefore behind the affected disc. This procedure, if performed properly, should be painless and better tolerated by the majority of the patients.

This procedure may also be performed for diagnostic purposes, where a smaller amount of steroid is injected. This use is known as a selective nerve root block.

This procedure is performed for diagnosis. Only 15% of back pain patients suffer from facet joint mediated pain. This causes pain with movement, known as mechanical back pain, such as pain experienced during rotation of the spine, or pain when bending backwards. Each facet joint is supplied by two nerves called a medial branch. They are branches of the dorsal ramus of the spinal nerve. The location of these nerves is fairly constant and can easily be blocked or numbed using local anesthetics. Numbness of those nerves would numb the facet joint reducing pain significantly and, over time, possibly eliminating the pain. If relief is achieved, the procedure should be repeated to make sure the first positive outcome was not a placebo or false response. Once the diagnosis is established beyond doubt, then those nerves are destroyed using radiofrequency generated heat (radiofrequency thermal neurotomy) for long term pain relief (therapeutic option). For further information please click here.

This technology is used mainly to treat facet joint mediated pain in the cervical (neck), thoracic (abdomen) or lumbar (low back) area. The most effective outcome of the treatment is seen in patients with neck pain. It is also effective for back pain provided the diagnostic facet joint block confirmed the diagnosis of facet joint mediated pain.

Once the diagnosis is confirmed (as discussed in facet joint injections above), this procedure is considered for long term pain relief. A Teflon coated, insulated cannula, along with a thermistor or thermocouple inside the cannula, is used to deliver heat to the nerve to destroy it. The active tip of the cannula ranges from 5mm to 10 mm. The thermistor probe inside the cannula delivers radiofrequency energy to the tissue while reading the local temperature of the tissue.

The radiofrequency waves generate motion in tissue molecules, which generates heat. Once the optimum temperature is achieved in the tissue, the temperature is maintained for a period of time resulting in the destruction of the offending nerve.

This is a diagnostic procedure. Once all conventional diagnostic and therapeutic procedures have been performed, this procedure is considered to establish a diagnosis.

Low back pain with pain in the buttock and coccygeal, or tail bone area, is usually from discogenic causes. Up to 40% of all back pain cases are from a discogenic cause, including intractable back pain. However, repetitive minor trauma, or a major trauma, may also produce intractable back pain due to an internally disrupted disc (IDD). The only way of diagnosing an internally disrupted disc is by performing a diagnostic discogram.

At our center, the lumbar discogram is performed using an Intellisystem syringe to measure the pressure at which the patient experiences familiar pain. This is the most important part of the diagnosis. After the pressure study has concluded, the patient may undergo a CAT scan of the lumbar spine to display the architecture of the disc, but this is not always required.

For cervical and thoracic discograms, only digital pressure using a 5 mm syringe is used to find the painful disc. Unlike back pain, neck pain stems more from facet joint arthropathy. The architecture of cervical disc is also different than the lumbar disc. In the lumbar area the demarcation of the components of disc is well defined (the disc is made up of nucleus and annulus and the junction of nucleus and annulus is well defined in lumbar area).

A discectomy is the surgical removal of abnormal disc material pressing on a nerve root or the spinal cord. This is an option for patients with a herniated disc. These patients often suffer from back and leg pain. The outcome is excellent when the herniaiton is less than 8mm and the herniation of disc is contained.

This is an ideal treatment for patients who are unable to walk more than 50 yards or stand for more than 5 minutes without severe leg pain, numbness, weakness, or heaviness caused by spinal stenosis. Spinal stenosis is a condition where the spinal canal diameter has narrowed because of ligament thickening, arthritis of small joints (facet joints), or disc bulges.

This procedure allows us to debulk the thickness of the ligament and increase the diameter of the canal slightly. Slight increases in diameter are enough to restore function and reduce pain. This procedure does not interfere with structural stability of the spine. However, the procedure is not meant to replace decompression surgery, but help those patients who would not qualify for surgery, or those that do not fulfill the absolute indication of surgery. For further information please click here.

Spinal cord stimulation therapy masks pain signals before they reach the brain. A small device, similar to a pacemaker, is surgically placed under your skin. It sends mild electric currents through thin wires to your spinal cord, stimulating nerves in the area you experience pain. The electrical stimulation modifies the signal from the nerves, and stops the brain from interpreting it as pain.

The procedure is performed in two stages. The first stage is a trial of the device and the second stage is permanent implantation of the stimulator device. During the trial, easily removable lead wires are placed in the affected area and hooked up to an external pulse generator to determine if relief is achieved. If adequate pain relief is achieved, the patient may elect to have the device implanted permanently. The lead wires and pulse generator will be surgically placed beneath the skin to deliver continuous relief.

This is an excellent option for pain stemming from nerve damage, failed back surgery with symptoms of back and leg pain, shingles pain, diabetic peripheral neuropathy, idiopathic peripheral neuropathy causing severe burning leg or feet pain, neck pain with arm pain from failed neck surgery, nerve injury from disc herniation, phantom pain, and many other indications. For more information please click here. Please visit the following links for more information: http://www.tamethepain.com and www.youtube.com/medtronicchronicpain

Colloquially known as a “pain pump”, this device is a method of giving medication directly to your spinal cord. The system uses a small pump surgically placed in your abdomen that delivers medicine directly to the cerebrospinal fluid that flows around your brain and spinal cord, bypassing the path that oral medication takes through your body. This results in a greatly reduced dose, as you generally need 1/300 the amount of medication that you would have taken orally.

The use of this device is indicated for controlling cancer pain, for treating severe muscle spasm, or to treat patients with end stage degenerative disc disease. It also offered to the patient who suffer uncontrolled side effects from oral opioid therapy. The procedure is performed in two stages. The first stage is the trial stage and the second stage is performed only after the trial has been successful. For details of the information please click here.

These procedures repair deformed fractured vertebra caused by osteoporotic fracture, traumatic fracture, or from damage from the spread of cancer. Vertebral fractures require prompt treatment as it causes significant debility and disability. If it remains untreated, it causes progressive worsening of spinal deformity leading to difficulty with breathing and proper oxygenation. Pain becomes uncontrollable. Progressive deformity may lead to multiple falls and further fractures, not only from the fall itself, but also from the deformity. Vertebroplasty and Kyphoplasty are performed in our pain treatment center. Both the procedures are performed under mild sedation and fluoroscopy guidance. We have successfully performed Kyphoplasty procedure in our office in a cost effective way.

This procedure is performed for treating intractable back pain because of vertebral body fractures or intractable discogenic pain where no other options are available for treatment. Usually a diagnostic block is performed first. If that is positive, a second block is performed to rule out a placebo response. Once the block provides concordant pain relief then RF or radiofrequency thermal lesioning is performed to achieve long term pain relief.

Known primarily for their ability to reduce the appearance of facial wrinkles, botox injections may also be used to treat severe migraines, headaches, myofascial pain, and excessive sweating in the armpits or hands (hyperhidrosis), among other things. Botox injections use a toxin called onobotulinumtoxin A to temporarily prevent a muscle from moving.